diabetes and ketones, diabetic sick day rules, DKA

KITLIVING

T

here are so many things

to be aware of and watch

out for when you have

diabetes, not to mention

understanding lots of

words and phrases that most people

don't have to think about. But knowledge

is the best way to help you manage your

condition and get on with your life.

Ketones are part of most people's

lives with diabetes, but hopefully not on

a regular basis. If you run a high blood

glucose for a few hours (hyperglycaemia),

you might be at risk of your ketone levels

rising too. They are also an issue if you

get ill. So, if you do come down with an

illness or infection, you'll need to be on

your guard that bit more than usual.

When anyone is ill, it's normal for blood

sugars to be higher as the body fights off

infection, so when you have diabetes it's

extra work to keep your condition under

control - especially if you're not feeling

well to boot. But it pays to be aware of

your diabetes control and understand

any risks because leaving your sugars

high can lead to diabetic ketoacidosis

(DKA). Much of checking your ketones is

about DKA prevention, as DKA is a lifethreatening

emergency.

What is DKA?

DKA mostly affects people with Type

1 diabetes, but can also affect people

with Type 2 on insulin. Put simply, DKA

develops when your blood sugar levels are

consistently high (it can be a factor at the

point of diagnosis with diabetes). A lack of

insulin means the body can't use glucose

for energy, so instead it breaks down

other tissue (usually fat, first). This causes

harmful substances called ketones to

build up and, as a result, makes the body

acidic (hence ketoacidosis).

Being aware of what DKA is, and

having plans in place to either prevent it

or deal with it when it happens, means

it can generally be avoided. You need to

check for, and then treat, the presence of

continued over

ketones. If you get ill, following 'sick day

rules' (see sidebar), will help you keep

on top of your blood sugars, as well as

knowing when to test for ketones and

what to do with the results.

There are a few ways to check for

ketones - some blood test meters do

(see sidebar), but you can also use urine

testing strips and even breath test strips

(also in sidebar).

Because high or sustained ketones

can cause DKA, be aware that high blood

glucose and ketones can also affect your

ability to make judgements about your

control and lead to confusion, much like

when you're hyper- or hypoglycaemic.

If you're ever unsure about what to do,

contact your diabetes team or GP as they

should be able to help you.

Signs you could have DKA include:

• weeing more than usual

• feeling really thirsty

• vomiting

• stomach ache

• fruity smelling breath (like pear drops)

• deep/fast breathing

• feeling really tired or sleepy

• passing out.

It could be hard to know if some of

these could be related to your being ill

with something else, like flu, so remember

to ask for help if you're unsure.

Make a plan

We know there'll always be a time when

an illness or infection can affect your

diabetes, so plan in advance about

the things you can do - it'll take the

guesswork out of it and give you some

reassurance that you have a back up plan

in place.

Your diabetes team can help you. Talk

to them about:

• Whether you might need to change

your insulin or medication dosage or

change the usual times you take them.

• Your target blood sugars and ketone

Your blood sugar level can indicate when

to test for ketones. The NHS advises to

check for ketones if your blood sugar is

over 11mmol/l. There are different actions

to take, depending on the result:

Blood ketone test

• Lower than 0.6mmol/l: normal, no

action required.

• 0.6 to 1.5mmol/l: slightly increased

risk of DKA, test again in a couple of

hours.

• 1.6 to 2.9mmol/l: increased risk of

DKA - contact your diabetes team or

GP as soon as you can.

• 3mmol/l or higher: very high risk of

DKA, get medical help immediately.

Urine ketone test

More than 2+: a high chance you have

DKA, get medical help immediately.

Test indicators

levels - how often to check them when

you're ill, and what to do if they're higher

or lower.

• Some ideas on suitable food and

drink to help keep up your energy.

Keep a note of what you talk about, as

all of these can form your 'sick day' rules

(see overleaf).

Index

  1. Desang diabetes magazine diabetes information
  2. Diabetes UK careline
  3. Desang diabetes magazine diabetes information, Sue Marshall
  4. Desang diabetes magazine diabetes news
  5. Desang diabetes magazine diabetes news
  6. Desang diabetes magazine diabetes news
  7. Dexcom CGM, continuous glucose monitoring
  8. Desang diabetes magazine diabetes news
  9. Ascensia Contour Next One Diabetes blood test meters
  10. Page 0010
  11. Senseonics Eversense implantable CGM, Roche Diabetes Care, Accu-Chek
  12. Abbott Freestyle Libre, Flash Glucose Monitoring, blood testing without lancets
  13. Abbott Freestyle Libre, Flash Glucose Monitoring, blood testing without lancets
  14. Abbott Freestyle Libre, Flash Glucose Monitoring, blood testing without lancets
  15. OurPath programme, Roche Diabetes Care
  16. diabetes and ketones, diabetic sick day rules, DKA
  17. diabetes and ketones, diabetic sick day rules, DKA
  18. diabetes and ketones, diabetic sick day rules, DKA
  19. diabetes and ketones, diabetic sick day rules, DKA
  20. Insulin pumps UK 2018
  21. Page 0021
  22. Insulin pumps UK 2018
  23. Insulin pumps UK 2018
  24. Insulin pumps UK 2018
  25. Medtronic Minimed 670G insulin pump
  26. Insulin pumps UK 2018
  27. Omnipod Insulet insulin pump with insulin pods
  28. Insulin pumps UK 2018
  29. Insulin pumps UK 2018
  30. Insulin pumps UK 2018
  31. Desang diabetes kitbags
  32. London Medical, London Diabetes Centre, private diabetes clinic
  33. London Medical, London Diabetes Centre, private diabetes clinic
  34. London Medical, London Diabetes Centre, private diabetes clinic
  35. London Medical, London Diabetes Centre, private diabetes clinic
  36. Making Carbs count: Counting carbs for the diabetic diet
  37. Making Carbs count: Counting carbs for the diabetic diet
  38. Accu-Chek Insight insulin pump
  39. Accu-Chek Insight insulin pump
  40. Free diabetes magazine, living with diabetes, the diabetic diet, carb counting

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